Yamamoto Yoshio, Kawakami Mamoru, Minetama Masakazu, Nakagawa Masafumi, Teraguchi Masatoshi, Kagotani Ryohei, Mera Yoshimasa, Sumiya Tadashi, Matsuo Sachika, Kitano Tomoko, Nakagawa Yukihiro
Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan.
Department of Orthopaedic Surgery, Saiseikai Wakayama Hospital, Wakayama, Japan.
Asian Spine J. 2022 Apr;16(2):270-278. doi: 10.31616/asj.2020.0402. Epub 2021 May 21.
A retrospective study of prospectively collected clinical data.
To identify preoperative psychological factors associated with patient satisfaction after surgery for lumbar spinal stenosis (LSS).
Associations between depressive symptoms, anxiety, and worse surgical outcome or patient dissatisfaction have been reported in LSS patients. However, the influence of preoperative pain catastrophizing and fear-avoidance beliefs on postoperative satisfaction is not well understood.
LSS patients who underwent decompression surgery with or without fusion were included. Clinical outcomes were measured before surgery and 6 months postoperatively using the Zurich Claudication Questionnaire (ZCQ); Visual Analog Scale (VAS) of low back pain, leg pain, and leg numbness; Japanese Orthopaedic Association Back Pain Evaluation Questionnaire; and the Medical Outcomes Study 36-item Short-Form General Health Survey (SF-36). The Hospital Anxiety and Depression Scale (HADS), Pain Catastrophizing Scale, and Pain Anxiety Symptoms Scale were used to evaluate psychological status before surgery. Patients were classified as satisfied or dissatisfied with surgery based on a ZCQ satisfaction subscale cutoff score of 2.5.
The satisfied and dissatisfied groups contained 128 and 29 patients, respectively. Six months postoperatively, outcome scores for the dissatisfied group were unchanged or worse than preoperative scores (p>0.05). Multivariate logistic regression analysis showed significant associations between dissatisfaction and preoperative low back pain VAS score ≥ median (odds ratio [OR], 0.27; 95% confidence interval [CI], 0.10-0.74; p=0.01), preoperative mental health SF-36 score ≥ median (OR, 0.26; 95% CI, 0.08-0.89; p=0.03), and preoperative anxiety HADS score ≥ median (OR, 3.95; 95% CI, 1.16-13.46; p=0.03).
Preoperative less severe low back pain, lower mental health, and higher anxiety are associated with patient dissatisfaction with lumbar surgery, not depression, pain catastrophizing, or fear-avoidance beliefs. Pre- and postoperative psychological status should be assessed carefully and managed appropriately.
对前瞻性收集的临床数据进行回顾性研究。
确定与腰椎管狭窄症（LSS）手术后患者满意度相关的术前心理因素。
已有报道称LSS患者的抑郁症状、焦虑与较差的手术结果或患者不满之间存在关联。然而，术前疼痛灾难化和恐惧回避信念对术后满意度的影响尚未得到充分理解。
纳入接受减压手术（有或无融合）的LSS患者。术前和术后6个月使用苏黎世跛行问卷（ZCQ）、下腰痛视觉模拟量表（VAS）、腿痛视觉模拟量表、腿麻木视觉模拟量表、日本矫形外科学会背痛评估问卷以及医学结果研究36项简短形式一般健康调查（SF - 36）测量临床结果。采用医院焦虑抑郁量表（HADS）、疼痛灾难化量表和疼痛焦虑症状量表评估术前心理状态。根据ZCQ满意度子量表临界值2.5将患者分为对手术满意或不满意。
满意组和不满意组分别有128例和29例患者。术后6个月，不满意组的结果评分未改善或比术前评分更差（p>0.05）。多因素逻辑回归分析显示，不满意与术前下腰痛VAS评分≥中位数（比值比[OR]，0.27；95%置信区间[CI]，0.10 - 0.74；p = 0.01）、术前心理健康SF - 36评分≥中位数（OR，0.26；95% CI，0.08 - 0.89；p = 0.03）以及术前焦虑HADS评分≥中位数（OR，3.95；95% CI，1.16 - 13.46；p = 0.03）之间存在显著关联。
术前较轻的下腰痛、较低的心理健康水平和较高的焦虑与患者对腰椎手术不满相关，而非抑郁、疼痛灾难化或恐惧回避信念。应仔细评估并适当管理术前和术后的心理状态。
